Wiki Billing as a provider doing surgery at a hospital with a product

[youngva462@gmail.com]

the doctor has surgical privileges at a hospital and performs surgeries there, and this has been fine. she now wants to start using a placental matrix injection during the procedures (mainly for achilles tendinitis and fasciotomies)

it seems the hospital orders the product, right?

if this is the case, how do we get reimbursed for the work our doctor does in applying the product?

arent you required to add a product code if you bill an application code on a claim?

im just so confused.

ive called the vendor and they say call the hospital. called the hospital (4 different depts) and they say "they dont know" or hung up on me.

any guidance is appreciated

i cant figure out what cpt or hcpcs to use either, but thats a different problem. just need to understand the process first.

 

[jkyles]

Hi there, I think the first challenge is to determine whether the injection is covered at all. Some MACs have issued LCDs that limit amniotic/placental treatments to certain conditions, such as non-healing wounds.

 

[youngva462@gmail.com]

Hi there, I think the first challenge is to determine whether the injection is covered at all. Some MACs have issued LCDs that limit amniotic/placental treatments to certain conditions, such as non-healing wounds.

yes, the provider has said she is doing it either way, its just if we will be eating the cost or are able to get reimbursed for it -- she cares more about helping the patients than being hyper profitable. wonderful for the patient, stressful for billing lol

i thought about calling and asking as well, but i dont know what cpt or hcpcs to use because its an injectable matrix (which im embarrassed to admit, did blow my mind)

 

[jkyles]

Yes, sorry. All I can say is I've only seen it covered for non-healing wounds and similar. I think all 7 MACs have issued LCDs addressing amniotic/placental products for musculoskeletal treatments, so you can start there.